Designing for Health: Trends in Dental Clinics

Oral health is an important component of primary health care, but one that many do not receive. 45 million Americans do not have dental insurance,1 and the Affordable Care Act does not require dental coverage for adults. Even with coverage, finding a dentist has become increasingly difficult. An estimated 30 million people live in a Federally Designated Health Professional Shortage Area and lack access to a dentist. 2

Those living in designated shortage areas and underserved communities may soon be able to find affordable care at a Health Center. Since 2010 and the passing of the Affordable care Act, we have seen an increasing number of Community Health Center and Federally Qualified Health Center (FQHC) expansion projects. Most of these include a dental program where preventative services are provided regardless of an individual's ability to pay. In 2009, 75% of Federally Qualified Health Centers (FQHC's) provided dental services. 3

Federally Qualified Health Centers are health care organizations that serve low-income patients in medically underserved areas, and meet specific criteria qualifying them to receive a number of financial benefits. These benefits include government grants and increased Medicare and Medicaid reimbursements. They provide comprehensive primary medical, oral, and behavioral health services, as well as enabling services such as transportation and translation. They serve individuals of all ages, regardless of a person's ability to pay. The federal statute governing FQHC's requires them to provide preventive dental services. Community Health Centers are similar to FQHC's, but they do not receive federal grant funds under the Health Center program.

Although the Affordable Care Act (ACA) does not require dental coverage for adults, it is one of the primary reasons for the surge of Health Center projects. The ACA has allocated increased funding to Health Centers in an effort to provide high-quality care to the large number of newly insured, especially those in underserved communities. The increased funding is also intended to help Health Centers expand operations by increasing the scope of medical, dental and behavioral health services provided. As a result of this increased funding, many are currently expanding their facilities or building new ones.

Community of Hope is one of the many Federally Qualified Health Centers that are expanding. Their recently opened headquarters in Washington DC includes 11 dental operatories. Kelly Sweeny McShane, Executive Director at Community of Hope, says "There is a real shortage of dental care in our community, especially for low-income adults. While it is a requirement of FQHCs to connect patients to dental care, we found that it was hard to find dentists who would accept Medicaid or the uninsured. Community of Hope, therefore, began providing direct dental care, with our own dentists. We have recently expanded the amount of dental care we provided due to unmet need, and see that it will become more important in our service offering. We also believe in creating integrated care, which includes oral health."

With this surge of expansion comes the opportunity for designers to help shape a new experience of primary health care. Perkins+Will has been working closely with a number of Health Centers and has developed a specialized understanding of their similarities and, more importantly, what makes each one unique. It is important to understand that a Health Center's personality is greatly influenced by the community it serves. As geography and demographic makeup vary, so do needs and preferences. There are population-specific health concerns, as well as cultural, language, financial, and safety considerations. There are social needs like homelessness and education. Even aesthetic preferences and finish appropriateness varies from one community to the next. As a result, each Health Center requires it's own brand identity. One Health Center should not look and feel just like the next.

It is estimated that 9 – 15% of Americans, or 30 to 40 million people, suffer from dental anxiety.4 This often leads to patients avoiding trips to the dentist, which can ultimately lead to a series of health complications. Therefore, creating a positive patient experience is as important for dental clinics as it is for medical clinics. A long wait time is a sure way to increase patient stress, so thoughtful space and operational planning can be implemented to gain efficiencies that improve patient flow and reduce wait times. One example of this is installing X-ray machines in every operatory, so patients do not have to be moved and then wait for use of the machine. In addition to improved flow, patient anxiety can be eased by creating bright spaces with access to natural light, and by introducing architectural elements and artwork as positive distractions.

There are fewer healthcare code restrictions for dental practices than traditional medical spaces, which creates expanded design opportunities. Freer regulations allow for more open planning concepts that utilize glass, partial height partitions and translucent screens to bring daylight deeper into the floor plate. With fewer infection-control restrictions, many clinics are considering shared common support elements between operatories, like sinks and X-ray machines. This not only cuts down on initial capital cost, important for any FQHC, but frees up space in the plan to incorporate artwork and other elements of positive distraction.

The trends we are seeing in oral healthcare environments, from expansions in underserved areas to the crafting of branded experiences, are just a small part of the changing healthcare design landscape. As implementation of the Affordable Care Act continues, designers will see the growth of certain project types and the emergence of others. This is an exciting opportunity for designers to help shape the future of healthcare spaces and redefine the patient experience.

David Cordell, IIDA, LEED AP ID+C, leads the sustainability efforts of Perkins+Will's Washington, D.C., office and has served as a project designer and technical coordinator there for over nine years. His experience includes working with a variety of client types on numerous LEED projects, several earning LEED Platinum certification. You can contact David at david.cordell@perkinswill.com.

Bonny Slater, NCIDQ, LEED AP ID+C, is an interior project designer at Perkins+Will in Washington, D.C., where she brings a research-based approach to every project. Her experience spans the globe and focuses on supporting health and wellbeing. She can be reached at bonny.slater@perkinswill.com.